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Researchers know a lot about the effectiveness of self-management for diabetes and how it works, but much of this knowledge has been gleaned from research done at university-affiliated medical centers.
A Robert Wood Johnson Foundation (RWJF) program is now attempting to bring these lessons to the real world with grants supporting demonstration projects in six primary care settings and at eight community organizations or partnerships.
Edwin Fisher, PhD, professor of psychology at Washington University in St. Louis, Mo., and national program director of the RWJF Diabetes Initiative, detailed lessons learned through the program during the American Diabetes Association's 66th Scientific Sessions, held June 9–13 in Washington, D.C.
Key components and supports for self-management include individualized assessment, collaborative goal setting, skills enhancement, follow-up and support, access to community resources, and continuity of quality clinical care, Fisher says. The role of this self-management structure is similar in treating any chronic disease.
Nine of the grantees are focusing on screening for depression to address the negative emotions and coping challenges associated with diabetes. For example, using culturally specific tools, such as promatoras, or health promoters, in the Hispanic community, has helped integrate psychosocial and medical interventions in the primary care setting despite inadequate resources, Fisher says.
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"Primary care doctors are loving this stuff and saying, `I get to practice medicine,'" he says.
The contributions of community health workers have proven valuable to many of the grantee programs, Fisher says. They teach skills such as healthy eating and glucose monitoring, help patients set goals and obtain health information, and offer encouragement and motivation.
"Community health workers are not candy stripers," he notes. "They are providing a critical service for all people, not just inexpensive care for poor people."
Fisher stresses that the evidence proving the benefits of diabetes self-management is in, and that it is time for a shift in the public understanding of what constitutes high-quality diabetes care, including structured resources outside the doctor's office.
"What's critical is not which intervention you use, but that you are doing collaborative goal-setting with your patients," Fisher says. "These are the standards of self-management. You need a variety of good practices rather than just the best practice."
Footnotes
To learn more about the RWJF Diabetes Initiative, visit http://diabetesnpo.im.wustl.edu/home.html.
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| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
